June 2014

2018 MIDTERM ELECTION

There's a bunch of data updates to The Graph on both the QHP and Medicaid side, but the biggest change is the new Medicaid enrollee data out of California, which has jumped up by a whopping 789,000 people from the last data that I had. Note that many of these may be stuck in a major backlog, in which case this number may or may not continue to grow substantially over the next few months as they're processed.

Almost all of the other data is also on the Medicaid side, of course, as Michigan, Kentucky, West Virginia etc. continue to quietly add expansion & woodworker enrollees to their tallies.

Finally, the estimated QHP total now sits at around 8.6 million (around 8,000 per day since the end of open enrollment, although this rate will likely drop down a bit as we move into the late summer and fall). On the other hand, that 8K/day is at the lower end of my current estimated range (currently estimated at between 9,000 - 12,000 per day, although this will fluctuate as more state exchange data comes in), so who knows?

Michigan's belated Medicaid expansion program continues to grind along...not only is MI up to 96% of the first year goal already, it's actually up to 63% of the total number who are eligible state-wide!

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 315,578
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

The Kaiser Family Foundation estimated that WV has 143,000 residents eligible for Medicaid expansion. This means the state has now enrolled nearly 89% of them:

"The fast-track enrollments, on average, cost West Virginia about $6.50 less than would a full Medicaid application," the report states, estimating the staff worker received $14 dollars per hour.

Multiplying the 71,860 people who enrolled by that dollar amount provided a savings of roughly $470,000, according to the report. The state spent $200,000 in IT upgrades that also allowed it to mine the SNAP data base for potentially eligible residents. Subtracting those costs, the report argues the state saved about $270,000.

Bowling said the most up-to-date data show about 128,000 people have joined Medicaid through the expansion, much more than the roughly 91,000 anticipated to sign up. She said that success means the state probably won't send out another round of letters, but the numbers keep rising as those eligible may sign up at any time.

Some days I forget just how friggin' HUGE the state of California is...

Part of the delays can be attributed to high demand. In California, as in many of the 26 states that opted to expand Medicaid eligibility under the Affordable Care Act, people turned out in much higher numbers than projected. The state health department said it now expects 2.2 million people to enroll in Medi-Cal by next month -- 300,000 more than estimated last fall.

Roughly 1.4 million of those applicants were newly eligible for Medi-Cal, which was expanded under the Affordable Care Act, commonly called Obamacare, to serve people who earn up to 138 percent of the federal poverty level. About 600,000 more were previously eligible for coverage but had not enrolled. Experts say the massive outreach campaigns across the country helped alert many of these people to their eligibility.

While the massive backlog issue is a serious problem, this story does give some nice solid numbers to plug into the Medicaid spreadsheet for the largest state in the country:

A nice unofficial update from Kentucky...but again, no QHP/Medicaid breakout. As I did last time, I'm going to play it cautiously and assume 90% Medicaid & 10% QHPs; since the combined total was around 421,000 last time, this brings the totals up to around 87,000 exchange QHPs and 363,000 Medicaid enrollees;

Sebelius later tweaked Sen. Mitch McConnell of Kentucky by pointing out that Kentucky’s state health insurance program, the Kentucky Health Connector, now has 450,000 people enrolled in it and many of them had no health care before.

OK, I could be dead wrong about this; if so, I've provided a second Hobby Lobby-related item to justify having this blog entry. Let me put the 2nd item out there just in case:

The Washington State Insurance Commissioner just issued an interesting immediate response to the SCOTUS Hobby Lobby decision...interesting, because I'm a bit surprised that a state insurance commissioner (which I generally thought of as a fairly non-partisan job...although this jackass from Georgia obviously proved me wrong on that one) would post something like this, especially so quickly:

Let’s start with this howler: “Actually, the Obama administration never said that they’d reach 7 million paying customers by March 31st.”Seriously? Has Mr. Gaba really not read the September 5, 2013 memo from Marilyn Tavenner (chief of Centers for Medicare and Medicaid Services) titled Projected Monthly Enrollment Targets for Health Insurance Marketplaces in 2014? Table 2b of that memo clearly shows an enrollment target of 7,066,000 for March 31, 2014. End of story.

The other day, Paul Krugman posted a short blog entry over at the New York Times in which he laid out 6 of the biggest anti-ACA attack points which have been, in his view, completely obliterated by reality:

The other day, Paul Krugman posted a short blog entry over at the New York Times in which he laid out 6 of the biggest anti-ACA attack points which have been, in his view, completely obliterated by reality:

Today, Maryland issued their latest report, which brings their data up through May 31st. After entering the new data, the overall projection chart has jumped dramatically and now stands at between 270K - 360K per month:

As I noted this morning, the Maryland Health Exchange has released an updated enrollment report running through the end of May (the June report will be out at the end of July):

As of May 31, 300,310 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.

As of May 31, 72,207 individuals have enrolled in a qualified health plan.

Compared with the previous report, MD had a 4,300 QHP increase from 5/10 - 5/31, and an increase of 4,450 since the end of the open enrollment period. This means that they're averaging around 106 per day, or 31% of their average rate during open enrollment...which has had a significant impact on the Off-Season Projection Chart that I started posting yesterday (as you can see, MD had been only running 2% of the OE rate until now).

The Obama administration on Thursday plans to issue much-anticipated instructions for Americans to reenroll for next year in the new federal health insurance marketplace — a set of rules intended to make it easy for consumers but that nevertheless will require some people to reapply through HealthCare.gov to preserve their subsidies or coverage.

Under the rules, people will need to do very little to remain in their health plans if their incomes and covered family members are not changing and their plans are offered again for 2015.

All 17 of the insurance companies participating in the federal ACA exchange this fall for Year Two of open enrollment have released their preliminary rate requests for 2015. It's important to stress preliminary, since the rates still have to be approved by the HHS Dept.Update: State insurance commissioner.

There could be some sticker shock, but some welcomed price cuts as well, when consumers go shopping for insurance this fall on the Michigan Health Insurance Marketplace, according to numbers the state released earlier today.

Overall, it appears that Michigan’s proposed average rate increase of just 2.2% is modest compared to changes in some other states, according to an ongoing analysis by consultant PricewaterhouseCoopers that so far has compared insurance pricing on more than a dozen state marketplaces.

That means the average premium cost in Michigan — $326.74 — remains lower than the national average premium of $360.

I gave a general overview of the reasoning behind my 200K - 300K per month off-season QHP enrollment estimate a couple of weeks ago, but I didn't get around to actually plugging the numbers into a spreadsheet and running the calculations until today. Here's where things currently stand:

As you can see, just as I did with my enrollment period projections (which were consistently proven to be 99%+ accurate), I'm using the data provided by the state-run exchanges since April 19th as the basis for my "off-season" projections. Unfortunately, not only is the HHS Dept. refusing to provide their monthly enrollment reports during the off season (which I've ranted about several times), but New York isn't doing so either (I already asked), and so far there's no word from California, Connecticut, Rhode Island or Vermont.

Over the years there have been a whole mess of court cases challenging the ACA, either en masse or sections thereof, and most of them have either been dismissed or absorbed into the law. The most famous of these was NFIB v. Sebelius, otherwise known as "the SCOTUS decision which upheld the ACA overall but made Medicaid expansion optional instead of mandatory."

Basically, the SCOTUS ruled that Congress couldn't enforce the individual mandate using a financial penalty, but it was all good because it isn't really a penalty, it's a tax, which Congress has every right to impose. Yup, the entire law hung in the balance over the semantics of a single word, which happens more often in court cases than you'd think.

However, there's still a half-dozen assorted cases left to be decided, and while most of them nibble around the edges of the law, one of them could potentially cause an epic clusterf*ck if it's successful: Halbig v. Burwell.

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler is asking all health insurers doing business in Washington state to end discrimination in health insurance based on gender identity and related medical conditions.

In a letter sent to health insurers this morning, Kreidler reminded health insurers that exclusions and denials of coverage on the basis of gender identity are against the Washington Law Against Discrimination (RCW 49.60) and the federal Affordable Care Act (Section 1557).

...“Transgender people are entitled to the same access to health care as everyone else,” said Insurance Commissioner Mike Kreidler. “Whether specific services are considered medically necessary should be up to the provider to decide on behalf of their patient.”

I contacted the NY State of Health exchange a couple of weeks back and spoke a couple of times with a very nice media relations woman who explained that yes, a highly-detailed, comprehensive enrollment report would be released sometime in late June, but that no, it wouldn't include any information about exchange enrollment since the end of the first Open Enrollment period (ie, the extension period which ended on April 15th).

She said that she'd see about trying to get "off season" enrollment data back on the agenda, but just like the HHS Dept. running 36 other states, it looks like NY has decided not to bother. This leaves me crossing my fingers that California will release their off-season data sometime soon; since CA handles almost 20% of the total enrollments by itself, that (combined with the other half-dozen state exchanges providing regular updates) should be enough to extrapolate for the rest of the country. NY is the 2nd largest exchange, however, so it would've been helpful if they'd done so as well.

Not much time to post today, but remember all the fuss & bother about how the ACA was going to cause massive increases in healthcare spending? Yeah, about that...

Pretty much everyone was stunned to see Q1 GDP growth slashed to -2.9% from an earlier estimate of -1.0%.

The revision largely boils down to one thing: healthcare spending.

"Two thirds of the revision is in consumption, cut to +1.0% from +3.1%," said Pantheon Macroeconomics Ian Shepherdson. "Almost all of this huge hit is in the healthcare services component, cut to -1.4% from +9.1%."

According to the BEA, healthcare spending went from adding 1.01 percentage points to subtracting 0.16 from the headline GDP growth number.

"So much for the BEA's initial view that the start of Obamacare triggered a surge in spending on healthcare," said Shepherdon. "The press release offers no detail on what triggered this massive revision."

Yesterday I tore apart a rather idiotic story by Sharyl Attkisson at the Daily Signal in which she bullshits her way through various ACA numbers, culminating in a completely absurd "infographic" which I helpfully corrected for her (so far she has yet to thank me for the assist).

Today I see that Hannah Bleau of the Daily Caller picks up Attkisson's ball o' crap and runs with it. I really don't have time to do another takedown today, so instead I'll just present two screen shots.

The first is the headline itself:

Um...no, Ms. Bleau, there has been no survey released which has made any such claim whatsoever. The Kaiser Family Foundation survey you're referring to states that 57% of the people who enrolled in QHPs via the ACA exchanges were previously uninsured. That is, 57% of the 8.02 million people who enrolled via the exchanges, or around 4.6 million (or, if you subtract those who haven't paid their first premiums yet, around 4.1 million).

This is a net increase of another 1,029 QHPs and another 14,151 Medicaid enrollees since June 12...or up 21,436 QHPs since the end of Open Enrollment on 4/19 (330 per day on average).

It's worth remembering that Oregon started the year with only about 559,000 uninsured people in the entire state. Add in the 128,434 "Fast Track" Medicaid enrollees and you have a whopping 444,000 people covered one way or the other.

A second nice DC find today by contributor deaconblues; as he put it, "so much for the triple-digit increases predicted by the Republicans"...

The D.C. Department of Insurance, Securities and Banking received proposed health insurance plan rates to sell on the District of Columbia’s health insurance marketplace, DC Health Link, for plan year 2015.

Four major insurance companies – Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare – have proposed rates for individuals, families and small businesses.

UnitedHealthcare proposed rate decreases of eight percent for all of their 2015 plans; Aetna and Kaiser Permanente proposed a mix of rate increases and decreases resulting in a slight overall net decrease for Aetna and a slight overall net increase for Kaiser; and CareFirst proposed rate increases for all plans. Most of the individual plans and all small business or “SHOP” plans reflect increases greater than 10 percent.

While that last item about CareFirst raising rates over 10% puts a damper on the good news, it may not be final:

PRINCETON, NJ -- Five percent of Americans report being newly insured in 2014. More than half of that group, or 2.8% of the total U.S. population, say they got their new insurance through the health exchanges that were open through mid-April.

These data are based on Gallup Daily tracking interviews with more than 31,000 adults conducted between April 15 and June 17. Those who say they have health insurance were asked if their policy was new for 2014, and if so, whether they obtained their policy through a state or federal health exchange or in some other way. The exchanges officially closed on March 31, although people who indicated they had begun the process prior to that date were allowed to continue to enroll through April 15.

So, let's see here. The Gallup poll only includes adults over 18, so...

Slowly but surely, Michigan looks like it may end up achieving 100% expansion enrollment by the end of the first year, an amazing accomplishment (especially considering that the GOP state legislature delayed the program by 3 months for absolutely no reason whatsoever, financial or otherwise):

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 307,143
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

For the most part, it lays out the major anti-ACA talking points (No One is Signing Up; the Policies are Too Expensive; But How Many Were Previously Uninsured?, There Won't Be Enough Competition, etc.), followed by the reality which has sliced through each of them, one by one like Toad's "List of Things to Do Today". To be perfectly honest, I was a bit surprised that he didn't bother including the chestnuts which have been disproven in the most spectacular fashion: The "But How Many Have PAID???" and "OMG!! 5MM Policies Cancelled!!" memes. Anyway, it's a good piece, and he concludes it as follows:

Good for him. Not only is this the right thing to do, assuming it goes through (it sounds like the logistics will be a bit awkward to implement under the circumstances), it also makes the Virginia Republican Party look like even bigger jackasses than they already did (and don't even get me started on the former Democratic state Senator who agreed to their bribery scheme).

Virginia Gov. Terry McAuliffe (D) said on Friday that he planned to act administratively to expand health coverage in his state, defying the Republican-controlled legislature that maneuvered to block him from expanding Medicaid under Obamacare.

The specifics of McAuliffe's plan aren't clear. But he vetoed an item in the Virginia budget Friday that would have required the legislature to approve any expansion and asserted that he planned to "move administratively" to expand coverage to as many as 400,000 low-income Virginians.

Yes, I know I just posted a Michigan Medicaid expansion update a few days ago, and the numbers since then are "only" up 4,000 since then, but this story has another important data point. Regular visitors should have noticed that the Medicaid spreadsheet and section of The Graph always seems to be somewhat higher than the CMS's occasional reports on actual Medicaid enrollment. The main reason is that there's a difference between Medicaid determinations and Medicaid enrollments; the HHS and CMS reports, along with the occasional state-level reports, generally only list how many people have been determined to be eligible for Medicaid. There's still a process that they have to go through in order to fully enroll.

Amy Lynn Smith has a great piece over at Eclectablog about the Get Covered America campaign, which is devoted to educating people about the law and helping them enroll:

The task of getting more people insured is never done. That’s why the Get Covered America campaign is kicking off a weekend of action on Friday. While celebrating its one-year anniversary of educating consumers about their new health insurance options, the campaign will be sending volunteers into communities across the country.

In addition, there's a related organization called Young Invincibles (hah!), specifically devoted to educating and assisting young adults (the sought-after 18-34 crowd) in enrolling, particularly during the off-season:

McKinsey itself stated no less than seven times throughout that it included both ON- and OFF-exchange enrollees, and therefore was pretty much useless for trying to figure out how many of the exchange-based QHP enrollees were "previously uninsured", since there was no separation between the two in the data. For all anyone knew at the time, there could have been twice as many off-exchange QHPs as exchange-based ones, and even if it was a 50/50 split, for all anyone knew, it could have been 0% prev. uninsured OFF exchange and 54% prev. uninsured ON the exchange. Basically, it was meaningless for that purpose.

I wrote a response piece which also included the HHS report about ACA subsidies covering an average of 76% of the premium cost for the Federal marketplace, but I didn't really have time to do a full analysis of the Forbes piece. However, I did note 4 major points which lept out at me right off the bat:

As of the end of the open enrollment period (4/19), New Jersey's exchange QHP total stood at 161,775; this hasn't been updated officially since. Their Medicaid enrollee tally was updated to 201,095 as of 5/30. That means that the combined total is up around 37,000.

The QHP/Medicaid ratio is tricky to estimate, not just because it isn't provided but because of the differing dates. However, I'll assume for now that NJ's off-season QHP rate has been running at around 20% of the total enrollment period rate of about 800 per day; that would make it 160/day, or 9,400 QHPs plus another 27,600 Medicaid enrollees:

The federal government reported in May that 161,775 Jerseyans bought insurance policies on the Marketplace since HealthCare.gov launched Oct. 1. The health insurers, however, are reporting enrollment numbers that exceed the government’s numbers. And experts predict those numbers will rise, since individuals whose health insurance policies don’t comply with ACA rules will be able to buy new policies on HealthCare.gov through 2014 as their old policies expire.

The DC exchange has always been a bit of an anomaly: It's one of only 2 exchanges where SHOP enrollments exceed QHPs (the other is Vermont), mainly because the ACA requires Congressional staffers to enroll via the DC SHOP exchange instead of their home states or even the DC QHP side. As a result, as of April 30th (the most recent update), the breakdown was 11,106 QHP's (25%), 13,230 SHOP (30%) and 20,497 Medicaid enrollees (45%). Add them up and you get 44,833 total.

As contributor deaconblues notes, the QHP number seems to be almost identical, so the bulk of the 3,200 additional enrollments are broken out between Medicaid and SHOP enrollees. I'll assume a 70/30 split until better data is made available.

A spokeswoman for DC Health Link said this week that reports of problems, “if true, were isolated incidents.” She noted that the exchange has enrolled more than 48,000 individuals and families; about 11,000 are enrolled in private plans.

In my previous entry, I added a comparison of my own families' old & new policy costs as an addition at the bottom of the article. However, I decided to move it to a new one for two reasons: First, after discussing the provisions of both policies with my wife some more, it turns out I was wrong about a few things; secondly, I've had quite a few people asking about my own experience (especially given my recent shingles outbreak), so I figured it was worthy of a separate entry.

The Washington Post reports today about a new report issued by the HHS Dept. which states that the average premium rate for those who enrolled via the Federal ACA exchange were cut by 76% thanks to the subsidies in the law:

The Americans who qualify for tax credits through the new federal insurance exchange are paying an average of $82 a month in premiums for their coverage — about one-fourth the bill they would have faced without such financial help, according to a new government analysis.

OK, I don't do business endorsements or paid promotions, but this is kind of a special case: 15 years ago today I co-founded my "day job" running Brainwrap Web Design.

By website development standards, that makes me an Old Man in the industry. I ran Brainwrap with an old college friend for the first year; we hit a slow patch and he decided to move on to a more stable corporate position elsewhere, selling his half of the business to me.

I ran the company by myself for another 13 years, until my wife (who had 20+ years of experience in corporate IT programming and management) started working with me. Her assistance was especially helpful during the ACA open enrollment period and my bout with Shingles, during which she took some of our normal site development work off my hands while I scrambled to keep up with the ever-changing enrollment data, so she deserves a lot of the credit for this site as well.

I debated whether I should bundle this point in with the prior Kentucky post, but decided it was worthy of a separate entry.

As I noted there, Kentucky has now enrolled around 335,000 people in Medicaid via the Kynect ACA exchange; an impressive number.

The thing is, according to the Kaiser Family Foundation, only about 350,000 Kentuckians who weren't insured prior to January qualified for Medicaid in the first place (including both woodworkers as well as ACA expansion). This means that theoretically up to 96% of all Kentuckians eligible for Medicaid have now been enrolled!

This isn't an official update; it doesn't give an exact number, and there's no QHP/Medicaid breakout, but it's better than nothing:

WASHINGTON – Kentucky Gov. Steve Beshear charged Tuesday that Senate Minority Leader Mitch McConnell and other critics of the federal health care law are being "disingenuous," attempting to be for a state program that is no different from Obamacare.

The governor called the state health care exchange known as kynect "highly successful," enrolling 421,000 Kentuckians — with 75 percent of them receiving coverage for the first time in their lives.

The final enrollment period breakdown was 82,792 QHPs and 330,615 Medicaid enrollees, or 413,407 total, so this represents an increase since 4/19 of 7,593 total.

If we were still in the open enrollment period, of course, I'd just use the same 20/80 ratio that the existing numbers suggest, but since we're in the "off season" for QHPs this is trickier. I'll assume a 10/90 ratio until I hear otherwise, which would mean that KY's QHP total is now up by 759 and Medicaid is up 6,834.

The good news: Illinois ACA Medicaid expansion is up to 350K, a 20K increase from 2 weeks ago. This represents 44% of the 800K eligible for the expansion program in the state.

The bad news (or good news, depending on your POV): There's nother 250K still in the hopper to be processed. Assuming the same 70% approval rate, that should increase the enrollment number by another 175K.

As of last week, Illinois' backlog of unprocessed Medicaid applications stood at 250,000, up from about 200,000 state officials reported in mid-March, but down from a peak of nearly 500,000 in early April, according to state data.

Since Oct. 1, the start of open enrollment in an expanded Medicaid program authorized by the federal health law, the state has received nearly 900,000 applications for public aid, most of which included Medicaid. Thus far, it has processed about 650,000 of them, granting coverage to about 450,000.

Roughly 350,000 gained Medicaid coverage under the health law, which expanded eligibility to all adults who make less than about $15,500 a year. The remainder gained coverage under old Medicaid parameters, which generally covered children, families and a category of older, sicker patients.

OK, the Medicaid number is a bit squirrelly since it isn't broken out by expansion/woodworkers/churn; the official number as of 4/19 was 27,268, so I'm estimating it at an even 30K.

Otherwise, the QHP total is for paid enrollees, up from 27,221, and the SHOP number is up from 33,614.

Vermont Health Connect has helped 144,500 Vermonters get health coverage. More than half, 80,400, were enrolled in Medicaid, many as a result of the program’s expansion under the Affordable Care Act.

However, the website was launched with significant problems, and eight months later it is still incomplete. State officials said this week that they will continue to rely on the two participating insurance carriers to enroll small businesses throughout the upcoming open enrollment period that begins Nov. 15. There are currently 34,800 people in that group.

There are also 29,300 people in the individual market who purchased commercial insurance. More than half, 62 percent, qualified for subsidies that lower the cost of those plans, though advocates say they are often still difficult to afford.

Since I started the ACA Signups project, I've generally restricted my posts to ACA enrollment-specific articles and data. After all, the subject of healthcare is so huge, and there's so many other far better sources for developments in the medical field, etc, that it seems best to stick to the subject at hand.

From January 1 to June 10 this year, California already had 3,458 cases of whopping cough, which already exceeds the number of cases reported in 2013, and following a surge in the incidence of the disease in the past two weeks, health official found it necessary to declare an epidemic.

Last week I made a bold estimate that at least 200,000 additional QHP enrollees are likely to be added each month from 4/15 (the end of the first open enrollment period) through 11/15 (the start of the next one). That's 7 months x 200K, or around 1.4 million on top of the 8.02 million confirmed QHP enrollees during the first period (well, technically the last HHS report runs through 4/19).

Nationally, the open enrollment period average was 8.02 million in 201 days (10/1/13 - 4/19/14), or an average of 39,900 QHPs per day (201 days...this includes everything from the disastrous website launches, to the December surge, to the February "lull", to the March insanity straight through to the April "extension period").

Of course, this wouldn't be such a mystery if the HHS Dept. hadn't cut off enrollment reports during the off-season, but I won't go on that rant again.

So where am I getting this 200K estimate during the off season? Well, let's take a look at the numbers we do have since then:

OK, it's difficult to get a bead on how Oregon has been performing since the end of open enrollment, because they bumped theirs out 2 weeks beyond most other states. Even so, they've added 19,214 additional QHP enrollees since the 4/19 HHS report, or over 350 per day.

Interestingly, there's been no change at all in their reported Medicaid enrollment; I'm assuming they just didn't include that data this week since it's changed some every other time.

More positive Medicaid news out of Arkansas (the 75% figure refers to those fully enrolled, but it's actually a bit higher: 76.4%. If you go by "determinations" it's even better, over 83% of the total eligible):

DHS spokeswoman Amy Webb said the figures released cover the month of May.

“Over 187,000 have been determined eligible. Just over 172,000 of those have already completed the enrollment process and now have full access to their private health insurance coverage. Overall we estimate that about 225,000 Arkansans would be eligible for the program so we’re about 75 percent there,” said Webb.

(I should note that the KFF estimates Arkansas' Medicaid-expansion-eligible number at more like 281K, but those are rough numbers and this woman is from the actual state program speaking so I'll defer to her on it).

A trifecta of updates out of the LA Times today thanks to contributor Brian W; can you count how many GOP talking points take serious damage below:

New data show the number of students without health insurance on California State University campuses dropped by 60% after Obamacare enrollment, defying concerns that not enough young people would sign up for health insurance.

...During the open enrollment period that ended in April, some officials worried that if not enough young, healthy people signed up for coverage, insurance companies would be left with too many sick and expensive customers, which would eventually cause carriers to raise premiums.

According to a poll released Thursday, at the 15 largest CSU campuses, approximately 30% of students were uninsured before enrollment began, and 10% were uninsured after. The drop accounts for 60,000 students who became insured, and illustrates the late surge of young people who signed up for policies.

So, yesterday I posted an item about how the ACA has cut Kentucky's uninsured rate by at least 50% since last October. This is significant news, but I also posted similar items about impressive uninsured rate drops in New Jersey (38%), Minnesota (40%) and especially Massachusetts (a good 86% or so, down to nearly zilch). All four posts received various levels of retweets on Twitter. However, the Kentucky one in particular apparently caught the eye of one David Simas, aka the "Assistant to the President and Deputy Senior Advisor for Communications and Strategy."

OLYMPIA, Wash. – The individual health insurance market grew 30 percent in one year to more than 327,000 people in Washington state, according to new information reported by health insurers to the Office of the Insurance Commissioner.

The latest enrollment numbers and other insurance market data also indicate that Washington state has succeeded in reducing the number of uninsured by more than 370,000.

Today’s individual market total includes 171,286 people enrolled outside the Washington Health Benefit Exchange, Wahealthplanfinder, and 156,155 people enrolled inside the Exchange as of June 1, 2014.

Since today seems to be "How much has the ACA cut the uninsured rate by in this state/that state?" day, I thought I'd dust off this TPM article from way back on April 1st:

Obamacare has cut Kentucky's uninsured population by more than 40 percent, signing up roughly 360,000 residents since enrollment opened up on Oct. 1, according to the Louisville Courier-Journal.

Some 75 percent of them -- 270,000 -- were previously uninsured. That means Kentucky's uninsured population of 640,000 has come down by 42 percent.

At the time, the headline read "Obamacare Cuts Kentucky's Uninsured Rate By 40 Percent", which was impressive enough. However, that was wayyyy back over 2 months ago. A little simple math tells the rest of the story:

In January 2013 a U.C. Berkeley report (pages 4-5) analyzed what Medi-Cal Expansion would mean to California. Now we can compare some of the predictions to what has happened so far. (The report uses the terms "newly eligible" for what is called "Strict Expansion" in ACASignups (i.e. childless adults ages 19-64), and "already eligible but not yet enrolled" for what ACASignups calls "woodworkers" or "previously eligible.")

Prediction 1: "With the adoption of the Medi-Cal Expansion, we predict...more than 1.4 million Californians will be newly eligible for Medi-Cal, of which between 750,000 and 910,000 are expected to be enrolled at any point in time by 2019." According to ACA Signups, more than 750,000 "newly eligible" had enrolled by mid-March 2014, including 650,000 moved into Medi-Cal from the Low Income Health Program on Jan. 1.

Quite possibly the lamest response to a "Good Obamacare News!" tweet I've seen to date, although it does crystalize the "taking our ball and going home" attitude taken by the GOP since open enrollment closed:

House Energy and Commerce Committee members sent letters requesting specific enrollment data, including the number of individuals who have paid their first month’s premium and demographic breakdowns. The committee has compiled the data that provides a snapshot of the true enrollment picture as of April 15, 2014, after the official end of the open enrollment period. Due to the administration’s repeated and unilateral extensions and changes, as well as the fact that many insurers have reported that individuals will still have time to pay their first month’s premium, the committee plans to ask the insurers in the federally facilitated marketplace to provide an enrollment update by May 20, 2014.

Greg Sargent has a nice piece in the WaPo this morning about a new Bloomberg News poll which uses "more accurate" wording to see what the latest zeitgeist on the ACA is, now that the dust has settled on the first open enrollment period:

...some of the law’s foes like to claim those polls are problematic because they offer a choice between “fixing” and “repealing” the law. This, they say, biases responses in favor of “fix,” because people like fixing things, and at any rate, Obamacare can’t be fixed by definition.

So this new Bloomberg News poll will pose an additional problem to those who simply refuse to accept the reality that, while disapproval of the law remains high, the American people still want to stick with it:

As I noted last week, the whole "Obamacare is socialism!!" mantra, which was always stupid in the first place, looks even sillier now with the news coming in from state after state that more and more private insurance companies are jumping into the ACA exchange pool. Now comes news from my own state of Michigan that the number on the exchange for the 2015 open enrollment season will climb from 13 to a whopping 18:

The state said today that it has received filing information from 18 health insurance companies wanting to be included in 2015 — five more than participated last year.

Department of Insurance and Financial Services Director Ann Flood said state residents seeking coverage through the marketplace will have even more plans to choose from and that "increased competition helps keep premiums lower."

Still, this doesn't take anything away from Minnesota's accomplishment; Mazel Tov all around!

The uninsured rate in Minnesota has fallen by more than 40 percent since the Affordable Care Act's coverage expansion started, a new report from the State Health Access Data Assistance Center shows.

The analysis appears to be the first assessment of how a state's uninsured rate has changed since the insurance expansion began in October. It shows that, between September 2013 and May 2014, the number of uninsured Minnesotans fell from 445,000 to about 264,500.

Wow! New Jersey's ACA Medicaid Expansion is up to over 201,000 people (43% of the total eligible population), helping reduce the state's uninsured rate from 21.2% to 13.2% in the past 8 months:

A monthly enrollment report showed that 1,485,576 state residents were covered by FamilyCare, which includes coverage through Medicaid and the Children’s Health Insurance Program. That total represented a 45,674-person increase from April and a 201,095-person increase since January 1, when the eligibility expansion went into effect.

The numbers suggest that the number of uninsured New Jerseyans has continued to fall since early March, when a Robert Wood Johnson Foundation-sponsored survey found that the percentage of state residents without insurance had already fallen to 13.2 percent, down from 21.2 percent in September.

At the end of the official enrollment extension period (technically 4/19), Colorado's exchange QHP tally stood at 125,402. As of the end of May, it was up to 132,815, with SHOP enrollments up to 2,135. This means Colorado's QHP total went up around 6% since open enrollment ended, or around 177 per day.

OK, I've only gone completely off-topic on this site like twice, but I'm just such a huge fan of this woman that I'm making an exception.

I'm very much aware that the bulk of my 15 minutes of fame pretty much ran out the moment that the first open enrollment extension period wrapped up, but the site still receives a decent amount of traffic so I figured, what the hell, might as well help give a deserving talent some additional exposure before what's left of my own spotlight dims completely.

Besides, there's been so much depressing news of late (more mass shootings by wingnut extremists, the ugly response by the GOP to the President bringing home an American POW, etc) that I figured I should lighten things up a bit for once. WIth that in mind...

Over 6 years ago, during the famous Obama/Hillary Presidential Primary Slugfest, I stumbled across a YouTube video of a talented woman named Rosemary Watson who absolutely nailed Hillary Clinton to a T in a hilarious bit called "New Hand Gestures":

When Massachusetts passed its landmark health coverage law under Gov. Mitt Romney in 2006, no one claimed the state would get to zero, as in 0 percent of residents who are uninsured. But numbers out today suggest Massachusetts is very close.

Between December 2013 and March of this year, when the federal government was urging people to enroll, the number of Massachusetts residents signed up for health coverage increased by more than 215,000. If that number holds, the percentage of Massachusetts residents who do not have coverage has dropped to less than 1 percent.

According to the Kaiser Family Foundation, Massachusetts only had around 242,000 uninsured residents out of 6.65 million total as of last September (about 3.6%), just before the ACA exchanges launched. So on the one hand, Massachusetts already had the lowest uninsured rate in the country due, of course, to RomneyCare, the precursor of Obamacare (no matter how much Mitt wants to deny it now, Lord knows why...)

So, it's been over a month since my last official update of The Graph. I've been debating whether to post any further updates of it, especially since the HHS Dept. announced that they won't be posting any more monthly exchange QHP updates, at least until the next open enrollment period starts in November. Without these, I have no official count of additional enrollments beyond the 8.02 million which were announced through April 19th.

However, I do have some official numbers since then, mostly on the Medicaid/CHIP side, and a handful of the state exchanges have still be providing regular updates (ironically, two of the states which continue to keep posting updates have the worst technical problems, Hawaii and Oregon).

Officials in Idaho say they’re undaunted by the well-documented failures of Obamacare exchanges in neighboring states and are moving full-steam ahead with plans to launch their own web portal this November.

While executives at Cover Oregon and Nevada Health Link abandon their state-run websites and turn to the federal exchange (HealthCare.gov), Your Health Idaho is headed in the opposite direction.

The state relied on the federal website for the open-enrollment period that ended in mid-April because it had less than 200 days last year set up its own web-exchange when state lawmakers authorized the project. It was one of two states — New Mexico is the other — that had to wait a year for its own site, and exchange officials say the delay has been a plus as they meet with other states to discuss what went right or wrong during Obamacare’s first round.

RICHMOND — Republicans appear to have outmaneuvered Gov. Terry McAuliffe in a state budget standoff by persuading a Democratic senator to resign his seat, at least temporarily giving the GOP control of the chamber and possibly dooming the governor’s push to expand Medicaid under the Affordable Care Act.

Sen. Phillip P. Puckett (D-Russell) will announce his resignation Monday, effective immediately, paving the way to appoint his daughter to a judgeship and Puckett to the job of deputy director of the state tobacco commission, three people familiar with the plan said Sunday. They spoke on the condition of anonymity because they were not authorized to discuss the matter.

Insurance experts say it's hard to know how many people opted to forego insurance and take a tax penalty and now have decided they want insurance, and also how many simply failed to sign up in time and now regret the decision.

But confusion over the new health law, also known as Obamacare, kept some from enrolling, health insurance experts say.

Some people thought they didn't have to meet the new health law's deadline because they didn't qualify for a premium subsidy from the federal government, said Carrie McLean, director of customer care at eHealthInsurance.com, a private Web-based insurance broker. Others thought that only people who wanted to purchase insurance through Covered California, the state's health benefit exchange, had to do so by March 31, she said.

And, according to a Kaiser Family Foundation survey in March, more than 60% of those without health coverage were unaware of the enrollment deadline for most people to sign up for individual health coverage.

Under the health care reform law, West Virginia expanded its Medicaid program to cover those who earn up to 138 percent of the federal poverty line, or about $16,000 a year for an individual. As of May 27, 123,403 West Virginia residents had signed up for Medicaid under the expanded program.

Though some analysts and even health plan executives believe there could be many double-digit percentage increases in premiums where some health plans underpriced for this year’s first year of enrollment to get customers, there have been examples where insurers are considering introducing even lower premiums than what they offered this year or new product with lower rates. A Bloomberg News report last week, for example, cited Molina Healthcare (MOH) in Washington State as offering a 2015 rate that is an average “6.8 percent reduction” from this year’s rate.

It's rather ironic that Oregon, which had a disastrous exchange website which it's abandoning in order to join the federal exchange, still continues to post their enrollment data on a regular basis (pretty impressive numbers at that, by the way--another 10,204 added to Medicaid in the past week or so), while the federal exchange, which has been running smoothly for months now, has decided to stop posting their own updates. In any event...

Don't let the snarky headline fool you; I'm still very much a single-payer guy. However, anyone who still claims that the ACA exchanges are "socialized medicine" doesn't have the slightest clue what they're talking about. In case you needed even more proof that the ACA is very much private-market friendly:

After sitting out the first year, UnitedHealth Group Inc. intends to offer individual policies on the Illinois health insurance exchange next year, according to sources familiar with the company's plans.

The decision by UnitedHealth, the nation's largest and the state's No. 2 insurer, has the potential to shake up the Illinois market, which was dominated in 2014 by Blue Cross and Blue Shield of Illinois, the state's dominant insurer.

...United's participation also could help lower rates for consumers, a key concern among the law's supporters.

While United would neither confirm nor deny its plans to offer policies in Illinois next year, a spokesman said the Minnesota-based insurer intends to increase its participation over time in exchanges nationwide.

By Cindy Mann, Deputy Administrator of the Centers for Medicare & Medicaid Services and Director of the Centers for Medicaid and CHIP Services

Medicaid enrollment continues to increase all across the country, especially in those states that have expanded their Medicaid programs under the Affordable Care Act.

As of the end of April, 6 million more individuals were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) as compared to the period before the initial open enrollment under the Affordable Care Act started. That includes 1.1 million additional people enrolled in April as compared to March in the 48 states that reported data for both April and March.

Finally, we have Nevada; while their QHP enrollment was pretty lame, their Medicaid expansion has done quite well. They have an estimated 304,000 people eligible for expansion, of which the state has already enrolled about 27%:

There were 467,000 Medicaid enrollees as of the end of April — 50,000 more than anticipated, said Mike Willden, director of the state Department of Health and Human Services. Of those 83,000 people are newly eligible childless adults who did not previously qualify.

Willden projected Nevada's Medicaid numbers will reach 600,000 by the end of the year.

An estimated 220,000 New Mexicans are eligible for expanded Medicaid benefits, and 121,000 of them signed up for the newly available coverage. Many of them found their way to Medicaid by visiting the insurance exchanges online, by talking with guides, or at enrollment events designed to encourage use of the exchange.

OK, looks like expansion Medicaid enrollments are starting to slow down here in Michigan; only about 8,000 more people signed up over the past week. Still, that's 55% of the half a million total Michiganders estimated to be eligible for the expanded program:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 276,662
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

Rand Paul has a habit of being just as much of a weasel as his senior counterpart Mitch McConnell on most issues, but occasionally being "refreshingly" honest. Case in point:

FRANKFORT — Saying he favors a full repeal of "Obamacare" but citing a "technical question," U.S. Sen. Rand Paul on Friday gave cover to U.S. Senate Minority Leader Mitch McConnell a week after McConnell said Kynect and the federal law are not connected.

..."There's a lot of questions that are big questions that are beyond just the exchange and the Kynect and things like that," Paul said.

"It's ... how we're going to fund these things."

...When asked a second time if he would want to dismantle Kynect, Paul said: "I would repeal all of Obamacare."